(2008/06) June 2008

cactus/ tera,

Seeing you gals discussing about labour and birth matter, me can no longer bear with one matter.

In fact i got one worry since last Fri check up but din posted out here coz i had been afraid it might caused panic to some mummies whom is trying to VBAC. But i think i'm not able to bear with it any longer as i think this place might be the best place to share and discuss together.

Actually, during last Friday check up, when my gynae was discussing with me on the VBAC process, he told me some conditions tat must be fulfill before he let me had vaginal birth (my 1st is c-sec).
1)i must had the strong determination for VBAC. (which i'm confident i had it).
2) Then baby must be less or around 3kg (this will depend on bb, but with current situation my bb might be more or less 3kg, so shldnt be a prob)
3) bb not breech (my bb head oredy turn down at this moment)
4) i'm not encourage to take any epidural (i'm aware and prepare for it)
5) Lastly, i must know consequences if my old wound tear during pushing, my bb will die. This is the thing i was shocked when i hear it as i tot once tear can just emergency c-sec. But my gynae told me there's no enuf time to react as once wound tear, the oxygen will enter within a min and cause some reaction in the womb and bb will die. He din explain further as he seems like this is not a big issue. I asked him what is the chances this will happen and he told me is 1/100.
Then after discuss with my hubby, i had decided to stick to my vbac plan unless baby is more than 3kg. Of course in the meantime i'll try to do more research on this areas as well.

I hope this peice of information does not affected mummies whom is trying for VBAC, but maybe you want to ask ur gynae opinion as well and share with me here.
 


ND's gal, the debate about epi can go on till the cows come home... yes, epi can help some mothers relax. but epi can also prolong labour, esp if given too early. So it's our luck loh.... sad to say..

your friend power leh! Good for her! I dun like selfish doctors. hmph!
 
Felicia, it's not true that bb will die is wound rupture!!! Really!! Gosh!! Ironically, today's paper - TODAY - ran an article about VBAC!. Only have emergency c-section. I can only imagine your doctor tellin you that your bb will die if your wound rupture because: (1) He is not confident about doing emergency c-section quickly, and (2) the hospital that you are delivering at doesn't have facilities/support staff suitable for an emergency c-section that quick.

I really dun know understand why your doctor told you that there's not enough time to react! Gosh!! I think you are right in doing more research. PLEASE don't be too worried k.

From what I know, KKH has the best facilities for emergency c-section. they can take a bb out in less than 3 minutes.

It's strange that your doctor doesn't want to explain further cos this IS a BIG issue leh!

Felicia, what type of c-section cut did you have last time? Bikini/low across your tummy/horizontal cut is it?
 
ND's girl,
i oreadi purchased the confinement shower n hair wash from little dreamers some time back liao cos strongly recommended by a fren whom had used their pdts before for her confinement abt couple of yrs back. wun be using the traditional bath herbs cos too troublesome as i be doing confinement on my own wif oni hb's help.
 
cactus,

o.. really? Then i must read up Today's paper.

My previous c-sec is bikini cut, horizontal.

Giving my gynae's nature, he seldom explain further unless is some certain or serious matter. Maybe he think me jus at wk30 and dont want to discuss further and he want me to think carefully before he discuss with me again.
 
feifei,

VBAC= vaginal birth after c-sec
Means that our 1st delivery is via c-sec but we want to choose normal/vaginal delivery for subsequent delivery.
 
feifei,

the plug is only for delivery, after delivery will be remove right.

My bb head is ored down since week 32, hope he will not change position as current is the ideal one.
 
Felicia, why will your bb die if wound ruptures? cos in normal c-section, the uterus will be cut open also and blood/air will go into the uterus but your bb shoud be able to breathe still cos connected by placenta?


The VBAC criteria in TODAY is quite different from what your doctor advised. (2) and (5) are not mentioned. instead, it says the best chance for a successful VBAC is bb being born between 37 to 40 weeks.
 
Felicia, there is another cut your doctor can use in an emergency c-section. It's vertical. This enables him to remove the bb quicker, but may have more bleeding for you.

If I were in your shoes, I will change doctor.... really. Dun really care. it's quite gross loh.. for your doctor to say something like that.
 
cactus,

Yup, i had the same qn on my mind as you. Coz cut open or vaginal oso will let oxygen in, but i just couldnt figure out then why wound tear will caused bb die. But at tat moment i was bit shocked when i hear my gynae said tat and din probe further.
Tats why i told hubby i'll look up more infomation before next visit so that i can asked my gynae again.
 
felicia,
I see...

Ellysia,
I tink so lor...wow, my bb's head was donw in my 28wk, but at 32wks, she went up again...so hope by fri, she can be head down =D.
 
felicia,
goodness....how can yur gynae say such things? well, if he has to say so, at the very least explain more in details y he made such a comment lar...i may sound mean here but i think he is jus trying to find an easier way out for himself for yur delivery cos yurs is a VBAC case n he doesnt wan to handle any complications shd it occur, so if u opt for a c-sec, it be easier on him too...jus my tot...
 
http://www.homebirth.org.uk/vbacur.htm

Felicia, this link may be helpful. It says risk of uterus rupturing is low, and increased with induction of labour. There are case studies on bbs who died/suffered brain damage due to the rupture but these resulted from slowness in conducting emergency c-section. Note: Bb doesn't die/suffer brain damage cos wound rupture, BUT cos of SLOWNESS.

The next question is, how much time does your bb have? 1 hour? (the link referred to a case where a bb died cos it took the hospital 1 hour to get manpower and facilities going for an emergency c-section) . The following question is, how much time does your doctor need.
 
cactus,

Just finished read thru the article on Today.

Btw, my gynae told me normally for a patient opting vbac, the gynae will be more cautious and if anything (even small matter)cope up, they'll suggest for c-sec as they dont wnat to take the risk.
I believe in this as most gynae dont really encourage vbac, like my collegue was so-called been 'forced' to had another c-sec when her gynae keep telling her about all the risk of vbac.
 
<font color="ff6000">cactus

wow cool!! im getting lazier as the day gets by.. dunno when i wil throw the white flag! *lol*</font>
 
cactus,

regarding if the case if past due date, my gynae recommend induce if past due date so that size of bb will not be too big to go through normal natural birth. unless bb weight is not overly high, and i am not too tired, i can still wait up to end of 1 week from EDD. But gynae said if bb weight is too heavy or i am too tired, i can ask for induce earlier than 1 week once past EDD.

Yest my bb head circumference is 3.2. Gynae said if past 3.5 will be harder to go natural liao.

so its not only the weight, size, it also depend on head circumference. do ask yr gynae on yr bb head circumference besides the weight, esp if u want natural.
 
Ellysia, there are risks involved in induction. you may want to read up more about it, and decide if you want to take the risk. to some pple, risk of even 0.0001% is also risk.

Yeah..head circumference is also a big thing.. so far, I'm quite lucky... my bb's measurements (except for the abodminal circumference) is at 50th percentile for its age since 24 weeks. Tummy circum is a bit less than 50th percentile.. so skinny baby I guess.. dun have daddy's beer belly yet!
 
crystal/ cactus,

Thanks for sharing ur opinion here. Actually i was bit dissappointed as well after i hear wat my gynae said coz i had the feeling he's trying to physco me to c-sec again.

But actually before choosing this gynae, i had done some research and in fact this gynae is one that got good comment on gynae whom support vbac. I know another gynae whom support vbac idea is paul tseng. But due to location issue, i choose this gynae.

I'm not too sure why now he seems not very encouraging. I remember during the early visit i did told him i'll be opting for VBAC , and he seems to be ok with my idea, but now... *sigh*
 
morraine,

my gynae can't give me HL just for resting at home, she only can give MC. So i doubt i will start resting at home soon.
 
Felicia, maybe he recently had a bad experience with a VBAC? Or maybe he suddenly doesn't quite want to do VBAC anymore? Maybe his own insurance premiums have gone up due to whatever recent incident so he prefer not to take anymore risks? I understand that O&amp;G doctors' professional insurance is quite expensive.
 
cactus and Felicia,

Dun go for vertical cut. I understand vertical cut will have higher chance of rupture and wound may even tear during pregnancy.
 
I did some quick research on the net. just hope to share some thoughts with you, Felicia.

(1) Risk of uterus rupturing is 1/100,. not a small risk. but bb may not die as a result. what causes bb to be harmed/die is slowness in reaction.

(2) Induction increases risk of uterus rupturing.

(3) Careful monitoring during labour will show up tell tale signs before the rupture. There can be intervention.

(4) Is your doctor quick enough to do an emerg c-section (assume the quicker vertical incision).

(5) Is the hospital set up to support a very quick emerg c-section?

If I were in your shoes, I would probably go over to KKH (for its facilities), pick a doctor who supports VBAC, agree to a more painful vertical cut if necessary, and refuse induction. But that's just me. I have a mind of my own. quite stubborn and will hold on very tightly to my beliefs.
 
feifei,

ya hope bb head go down and will remain down.

My bb haven't engage yet, in fact gynae said from signs still early.
 
Ellysia,

I suggested vertical cut cos that's the quickest way to get bb out. But yes, after this vertical cut, Felicia cannot have another chance at VBAC already... BUT then again, VBAC is never recommended for mothers with twice or more than 2 times c-section, even if it is horizontal cut. So Felicia has nothing to lose with a vertical cut (save for more bleeding and higher chance of infection for herself).
 
cactus,

if u are past yr due date, gynae won't let u go beyond 9 days. tats for sure.

so no matter wat, if u are past due date, u only have 2 choices. induce or c-sect. so of course people like us who prefer natural will rather do induce.

i had a colleague who was overdue and she has no choice but to c-sect cos her bb is not engaged yet. cos if bb not engage, it be hard to induce and may utimately end up c-sect. so she straight choose c-sect.
 
cactus,

there is a lot of risk with vertical cut. wound rupture more easily. Not saying abt VBAC but if accidentally the mother got another pregnancy in future, she probably has to abort it bec' once tummy expand, vertical cut may cause the wound to rupture unlike horizontal cut.

tat is why most doc will do horizontal cut nowadays. vertical cut is done in the past days but it also cause wound ruptures which is why doc nowadays prefer horizontal cuts.
 
Ellysia, my SIL's son was allowed to be born naturally... he was born beyond 9 days after EDD. Contractions hit her only at week 41, day 5.... in her case, she did a scan, and her placenta was still okay and there was still alot of water so she was allowed to wait up to week 42. That was the ultimate cut off for her. Her bb engaged quite late.. at week 36 or 37. But not as late as your colleague.
 
Ellysia, but if I were Felicia, I will still go for a VBAC attempt, and allow the doctor to do a vertical cut (as a compromise mah!). actually this also depends if Felicia wants bb #3.
 
actually, vertical cuts are still done today.. but only for those crash c-section cases... like, bb must be born under 1 minute type of cases.. I think only KKH has such facilities.
 
morraine,

yah she says not good to give HL when didn't stay in hospital.. but mog says she got give her for 1 week stay at home due to some probs lah.. so i tink she will only give when got prob.. she probably won't give unless really need it.

In fact she hinted tat work till labour is better bec' office work will make us do more exercise and can make labour faster... she only suggest i take 1 week before EDD but using ML lah. If i want to use MC she can give lor. But i where got so many MC..
 
Thanks cactus dear! I guess my gynae might be unwilling to do it... hmm, I respect his decision coz he's afterall the head of foetal assessment at TMC so if he say no liao, i better dun take the risk...


Regarding VBAC, a may mtb friend who is currently seeing the same gynae as me is also planning for vbac. But our gynae never tell her cannot take epi, bb more than 3kg. etc..he even encourage her to try vbac though he tell her bb will be 3.5kg at birth... guess she better check again to play safe


felicia, could be ur gynae earns more from c-sect hence he's encouraging you to c-sect? I agree with cactus, do more research on it

hi tera
Dun worry your bb is definitely not oversized, like what the rest says so im sure can opt for natural birth


hi zuen, dun worry and update us again on bb after ur visit k? God is good and all will be fine
 
felicia,
my colleague told me dat years ago his wife chose to VBAC delivery for their 2nd child but halfway through her wound rupture also..so got to do emergency c-sect..but the bb is ok leh..now his daughter oredi 18yrs old leh..so i think the chances of bb dying is very low lah..imagine 18yrs ago the technology n facilities not so advance leh..bb can still survive..i am sure the chances is super low...so dun worry lah..
 
cactus,

dun tink so lah.. most hospitals shd have tat kind of facilities.

if not people won't go those expensive private hospital liao..
 
<font color="ff6000">ellysia

oic..

erm not true tat if u are past yr due date, gynae won't let u go beyond 9 days.. it depends.. they are onli worried on mum's BP &amp; if the bb poos or not more..</font>
 
felicia,

i tink doc just say bec' its kind of disclaimer, he has to let u know abt all the risk..
but like cactus say maybe he dun have confidence of VBAC.. but if u comfy with him then cont..if u want to change is it too last min?.

cactus,

i tink felicia is stopping at 2.. remember she said b4 lah. But Just in case, if we didn't go for those operation or means to stop anymore, sometimes unplanned pregnancy can happen. i am referring to tat kind of scenario. things dun always go as plan smoothly one.
 
Felicia, actually Ellysia brought up a good point. even if you do research and think there is a chance your doc doesn't want to take the risk, you can't confront him with your research cos you would have already lost confidence in him right? And if you dunw ant to change doctor then the only way out is to go along with what your doctor suggests - dun try VBAC. I'm jhust a little curious why your doc now changed his mind... since you say he initially supported VBAC... hmm.. maybe his insurance premiums went up lah.He is scared.
 
cactus,

dunno i have poor impression of KKH..
somehow i tink pte hospital has better facilities and better medical staff. esp the nurses. not the mention the long q at KKH.

maybe tat time u go is pte suite so yr experience is different?

but to be objective, we shouldn't comment on the hospital facilties or staff bec' we are not working inside, won't know the details so much.
 
hi ZuEn,

thanks for sharing ur thoughts in my SILs shoes.... i nv expect SILs might have e same thinking as u in terms of putting baby's items in their room cos all e while i thought they should be understanding tat e room belongs to my kids n i really need a place to put things now is not tat i'm now without kids. If now i'm without children just like e past only me n hubby, 2 SILs n MIL then i never invade their personal area at all, i dont even go into their rooms. like wat i mention eariler MIL n elder SIL sharing 1 room then younger SIL has her own room n me n hubby has our own room BUT now things change n i've never want back SIL's room for e past 2yrs after having my son but now my girl is arriving n my room is really cramped up with stuffs n i'm not expecting my boy n girl to have their own room now but i just need a place to store my baby's stuff.
Like ur mum, my MIL dotes my hubby very very much too, she is also those old fashion woman who dotes on boys. All e while she have been wanting to sell away her house to pay for my hse's instalments which i rejected cos I dont want them to thk tat my hse is like theirs since MIL sell e old hse to contribute.... like ur mum my mil also dont dare to provoke me cos he knows his son side me very much n she will always on e losing end but watever thgs happen is always becos of some reasons tat is really she is in e wrong end n not tat i purposely make my hubby scold her. I know she always complaint to SILs abt me but i dont care n SILs also dont dare to tell me off cos so far since i never scold their mum directly they cant do anythg to me. MIL also hates my maid cos she listen to me only..... therefore i did tell me maid if anythg happens at home she has to tell me so tat if MIL complain to SIL n SIL tell me i can stand by her if it is not her fault (just like there are many times my MIL trys to feed my boy with food tat my boy cant take so maid got to tell MIL no no no... then MIL angry with her n scold her but my maid very clever cos she know e danger of my boy taking some food when too young and if my boy got rashes she will be blame n not my MIL).
Anyway thanks a lot for sharing your thoughts with me.... now i can understand my sil more although i still hope they can put themselves in my shoes which i know is never possible cos they are not married n they dont have kids.
 
cactus,

maybe not scared just not confident enuff.

It depend on felicia's trust in her doc lah.

must really feel comfy with gynae then birth won't feel scared one.
 
1372543.jpg
 
Roxy,
My gynae package is quite fix. Even diff between normal and c-sec is only about $200-300 only.

Bizz,
Thanks for your assurance.

Cactus/ ellysia,
I was reading the webpage that cactus provide to me tats why din reply.
Yup, i'll stop at 2, hopefully lah
I'll again discuss this further with my gynae on my next visit. Will see how confidence he is on such cases. And will get to know more on his past history on vbac as well.
Really appreciate you gals feedback and suggestion on this, at least can help me to think clearer.
 
cactus, i oso check with KKH whether I can still opt for the delivery package if admitted as emergency cases... but i think my gynae dont go to govt hospital leh.. ;(
 


cactus,

maybe i am being skeptical but i tink since yr hb didn't work in other pte hospital also can't really based on tat opinion alone too.

why i want to say this is bec' i dun feel it is good to influence felicia on the choice of hospital - switch hospital or gynae or watever.. just let her consider herself.
 
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